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SANAAQUIN <br />!WW 1) COUNTY <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Res <br />.,„ <br />CONSTRUCTION <br />Yes 0 No El Stove Pipe COMPLETION El Christie Box Public Water System Onsite: <br />Ground Surface <br />casing <br />height <br />CI-IPIISTY-BOX <br />COMPLETION <br />Yes EN° Verified Chain of Custody: <br />SPOILS <br />Total Depth: <br />Drilling Rig Type: re1e4.0 44S-1 <br />LIlYes 1=1No <br />To: <br />To: <br />To: <br />To: <br />Date: 2/19 /// Inspector: <br />/5' <br />06-69,1"-i <br />Facility Address: dSV S• DAAtryweri €4" <br />Well Address: <br />WP# c,c731 Z5 7 Well#: <br />Soil Boring#: E <br />Drilling Company: <br />Driller Onsite: Acib fr <br />Consultant: diC- <br />Geologist: 37,0 144/04," <br />ort <br />7;ftrwi <br />Screening Method: <br />Contamination Noted: 0 Yes ON° <br />If yes, spoils storage Location: <br />Covered: LI Yes EN° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 70 <br />Depth to Water: 37 ; <br />Grout Material: 4401 eet.e...4 <br />Gallons of Grout Used: / 2-j/ /zj <br />171 Well Installation OWell Destruction <br />lilBoring Installation 0Boring Destruction <br />METHOD USED <br />EPressure Grout DOver Drill <br />0 Gravity NiTremie <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />cement 941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17,5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />From: <br />From: <br />From: <br />From: <br />111 Yes EINo